Credentialing

Overview

Our Network Operations Department builds and manages provider networks that offer price, access and quality sufficient to support competitive premiums. Since 1996, we have been dedicated to fully credentialing providers who apply for participation in our networks. Our credentialing program is accredited by Utilization Review Accreditation Commission (URAC) for our HMO and Preferred Care PPO networks. All provider information in the credentialing process is considered highly confidential.

BCBSLA credentials both individual providers and facilities. Individual providers and facilities interested in participating in our networks are required to meet certain criteria. Every practitioner must practice in an acceptable professional location that ensures confidentiality of procedures and minimal risk to the members. An acceptable office location does not include the home of the provider or member. To find out more about credentialing requirements, use the links below:

Note: We delegate credentialing to Magellan Behavioral Health for the HMOLA network for a select self-funded member group and to Ochsner Clinic Foundation for all networks. Blue Cross retains the final authority for provider's approval into our networks.

Receipt of an application or agreement does not guarantee acceptance into any network. The credentialing process can take 30-60 days* from receipt of the application; providers will remain non-participating in our networks until their credentialing application has been approved by the Credentialing Subcommittee. We will not allow a provider to participate in any network until their credentials have been approved by the Credentialing Subcommittee. We do not back date network participation prior to the approval date. The credentialing approval date becomes the effective date of network participation, unless a future date is requested. Providers may appeal subcommittee decisions using the guidelines on the Appeals and Terminations page.

*When the credentialing department receives all required information and does not need to request clarifications and/or corrections.